MASARYK UNIVERSITY FACULTY OF INFORMATICS E-health cloud specificities: How to deploy infrastructure for e-health cloud applications Master’s Thesis Sokolova Evgeniya Brno, 2017 Declaration Hereby I declare, that this paper is my original authorial work, which I have worked out by my own. All sources, references and literature used or excerpted during elaboration of this work are properly cited and listed in complete reference to the due source. Evgeniya Sokolova, December 30, 2016 i Abstract The thesis focuses on eHealth cloud specificities and infrastructure deployment for eHealth cloud applications. The Theoretical background chapter contains fundamental information about cloud computing technologies and eHealth. This chapter also describes differences and similarities between regular and eHealth cloud. The Analysis chapter is focused on the selection of Cloud Management Software and medical application for eHealth cloud, based on comparison analysis. The Implementation part describes the design of eHealth cloud infrastructure to run eHealth cloud application and its implementation process, which also includes system testing and the following discussion regarding implementation results. Keywords Cloud computing, eHealth, eHealth cloud, Cloud Management Software, OpenStack, Electronic Health Records. ii Acknowledgement I would like to express my gratitude to my supervisor Mgr. Kamil Malinka, Ph.D for all his useful comments, remarks and inspiration during my work on this thesis. Furthermore, I would like to thank Mgr. Tomáš Sapák for all his help and consultations. I thank to my family for providing me with unfailing support through the process of writing this thesis. iii TABLE OF CONTENT 1 INTRODUCTION ....................................................................................... 1 1.1 Structure of the thesis ................................................................................... 3 2 THEORETICAL BACKGROUND ........................................................... 4 2.1 Cloud computing ........................................................................................... 4 2.1.1 Elements of cloud computing ...................................................................... 4 2.1.1.1Essential characteristics ....................................................................... 4 2.1.1.2Service models ..................................................................................... 5 2.1.1.3Deployment models ............................................................................. 6 2.2 Study of eHealth ............................................................................................ 9 2.2.1 eHealth forms .............................................................................................. 9 2.2.2 EHR vs EMR vs PHR ............................................................................... 11 2.2.2.1EHR deployment models in EU ......................................................... 13 2.2.3 Information security requirements for eHealth ......................................... 15 2.3 eHealth cloud ............................................................................................... 18 2.3.1 Benefits of eHealth cloud .......................................................................... 18 2.3.2 Challenges of eHealth cloud ..................................................................... 20 2.3.3 Differences between regular and eHealth cloud ....................................... 24 3 ANALYSIS ................................................................................................. 26 3.1 Deployment model of eHealth cloud ......................................................... 26 3.2 Cloud Management Software .................................................................... 26 3.2.1 Eucalyptus architecture ............................................................................. 28 3.2.2 OpenNebula architecture ........................................................................... 29 3.2.3 CloudStack architecture ............................................................................ 31 3.2.4 OpenStack architecture ............................................................................. 33 3.2.5 Comparison analysis ................................................................................. 34 3.2.6 Conclusion of CMS comparison analysis ................................................. 41 3.3 Electronic Health Records software .......................................................... 44 3.3.1 EHR functionality ..................................................................................... 45 3.3.2 ClearHealth................................................................................................ 45 3.3.3 Vista .......................................................................................................... 46 3.3.4 FreeMED ................................................................................................... 46 3.3.5 OpenEMR.................................................................................................. 46 3.3.6 Conclusion of EHR comparison analysis .................................................. 47 iv 4 IMPLEMENTATION ............................................................................... 47 4.1 Test environment ........................................................................................ 47 4.2 OpenStack installation................................................................................ 48 4.3 OpenEMR requirements ............................................................................ 51 4.4 OpenEMR architecture design .................................................................. 52 4.5 Implementation of OpenEMR architecture ............................................. 56 4.6 eHealth cloud implementation issues ........................................................ 59 4.6.1 OpenStack installation issues .................................................................... 59 4.6.2 OpenEMR installation issues .................................................................... 59 4.7 System testing .............................................................................................. 59 4.8 Discussion..................................................................................................... 61 5 CONCLUSION .......................................................................................... 63 6 LITERATURE ........................................................................................... 65 7 APPENDIX................................................................................................. 74 v List of figures Figure 1: Cloud service models [2] ............................................................................... 6 Figure 2: Illustration of private cloud in healthcare domain [13] ................................. 7 Figure 3: Illustration of public cloud in healthcare domain [13] .................................. 8 Figure 4: Illustration of hybrid cloud in healthcare domain [13].................................. 9 Figure 5: Electronic Health Records diagram [6] ....................................................... 12 Figure 6: EHR architectural models [12] .................................................................... 14 Figure 7: Security objectives in eHealth [12] ............................................................. 15 Figure 8: Common root causes of security incidents [12] .......................................... 23 Figure 9: Eucalyptus conceptual architecture [19] ..................................................... 30 Figure 10: Opennebula conceptual architecture [21] .................................................. 31 Figure 11: Cloudstack deployment architecture [22] .................................................. 32 Figure 12: Cloudstack architecture [22] ..................................................................... 32 Figure 13: Openstack conceptual architecture [46] .................................................... 35 Figure 14: eHealth cloud infrastructure ...................................................................... 51 Figure 15: eHealth cloud model .................................................................................. 52 Figure 16: eHealth cloud application infrastructure – Normal setup .......................... 56 Figure 17: eHealth cloud application infrastructure – Server failure ......................... 57 Figure 18: eHealth cloud application network topology in OpenStack ...................... 58 Figure 19: eHealth cloud virtual instances in OpenStack ........................................... 74 Figure 20: HAProxy statistic report ............................................................................ 75 Figure 21: OpenEMR logging page ............................................................................ 76 List of tables Table 1: Comparison of open source cloud management software ......................... 41 Table 2: Openstack releases [46] ............................................................................. 43 Table 3: Test cases for ehealth cloud system ........................................................... 61 vi 1. Introduction Nowadays cloud computing technologies are widely implemented in different areas. Despite the fact that cloud computing is actively used around the world, it still stays as a hot topic for discussions. Many researches have